Moving forward on primary care transformation: The
Official blog for the Centers for Medicare & Medicaid Services,
originally published January 23
By Dr. Patrick Conway, CMS Deputy
Administrator for Innovation and Quality and Chief Medical Officer
26, 2015 -Today, we at the Centers for Medicare & Medicaid Services
(CMS) are excited to announce the promising findings from two
large-scale tests of advanced primary care: the Comprehensive Primary
Care (CPC) initiative and the Multi-payer Advanced Primary Care Practice
The CPC initiative, in its first
year, decreased hospital admissions by 2% and emergency department
visits by 3%, contributing to the reduction of expenditures nearly
enough to offset care management fees paid by CMS. The MAPCP
Demonstration generated an estimated $4.2 million in savings through the
use of advanced primary care initiatives.
These two programs are part of
broader efforts to deliver better care, spend dollars more wisely, and
have healthier people and communities.
Comprehensive Primary Care
With authority from the Affordable
Care Act, the CPC initiative is a unique multi-payer partnership between
Medicare, Medicaid private health care payers, and primary care
practices in four states (Arkansas, Colorado, New Jersey and Oregon) and
three regions (New York’s Capital District and Hudson Valley, Ohio and
Kentucky’s Cincinnati-Dayton region, and Oklahoma’s Greater Tulsa
region). This initiative includes providing care management for those at
greatest risk; improving health care access; tracking patient
experience; coordinating care with hospitals and specialists; and using
health information technology to support population health. Practices
receive non-visit based care management fees from the participating
payers, and the opportunity to share in savings.
In the first year, 492 practices
participated, serving about 345,000 Medicare beneficiaries and more than
2.5 million patients overall. Results from this first year suggest that
CPC has generated nearly enough savings in Medicare health care
expenditures to offset care management fees paid by CMS.
● The primary sources of the
savings were reduced rates of hospital admissions and emergency
● The bulk of the savings was
generated by patients in the highest-risk quartile, but favorable
results were also seen in other patients.
● Over 90 percent of practices
successfully met all first-year transformation requirements.
● The expenditure impact
estimates differ across the seven regions.
● Additional time and data are
needed to assess impact on care quality.
Results should be interpreted
cautiously as effects are emerging earlier than anticipated, and
additional research is needed to assess how the initiative affects cost
and quality of care, beyond the first year. Because the effects of the
CPC program are likely to be larger in subsequent years, these early
results are consistent with the possibility that the model will
eventually break-even or generate savings.
Multi-payer Advanced Primary Care
The MAPCP Demonstration is
multi-payer initiative in which Medicare is
participating with Medicaid and private health care payers in eight
advanced primary care initiatives in Maine, Michigan, Minnesota, New
York, North Carolina, Pennsylvania, Rhode Island, and Vermont. Unlike
CPC, the states convene the participants and administer the initiatives
rather than CMS. Under this demonstration, participating practices
and other auxiliary supports (e.g., community health teams) receivemonthly care management fees from the participating payers and
additional support (e.g., data feedback, learning collaboratives,
More than 3,800 providers, 700
practices, and 400,000 Medicare beneficiaries participated in the first
year. During the first year, the demonstration produced an estimated
$4.2 million in savings. Also, the rate of growth in Medicare FFS health
care expenditures was reduced in Vermont and Michigan, driven largely by
reduced growth in inpatient expenditures. There is less evidence that
the state initiatives were able to reduce hospitalization, readmission
and emergency department visit rates. Additional findings in this
evaluation period include:
● The MAPCP payments provided
needed support to help practices transform the way they deliver and
coordinate care, including use of nurse care managers or care
coordinators, restructuring of staff, improvements in patient flow,
adoption of health information technology, and more frequent staff
● Medicare was able to integrate
seamlessly with the structure and organization of the eight state
initiatives. Medicare’s participation sent a strong signal about the
importance of primary care and the potential of these programs, helping
to affirm payer and provider commitments.
● Although collecting and using
data was a recurring challenge, health information systems facilitated
the transformation process.
These first-year results illustrate
the potential for steady improvements in the participating practices’
advanced primary care capabilities. CMS anticipates continued
improvements as the participating practices deepen and refine their
methods of delivering advanced primary care so that patients can
continue to receive improved quality and coordination of care.
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